Paolo Pazzaglia

Differentiation of “Absence Status” and “Temporal Lobe Status”*

The absence statuses, which manifest themselves clinically as a simple dullness of consciousness, constitute only a part of the episodic psychic disturbances accompanying the generalized protracted spike and wave discharges.

Epilepsy presenting as memory disturbances.

Summary: Six patients presented with severe adult‐onset memory deficit that was subsequently diagnosed as complex partial epilepsy. In three cases acute amnestic episodes also occurred. The seizures were characterized by short losses of contact and oral automatisms. Interictal EEG showed temporal abnormalities of varying degrees. Formal neuropsychological assessment revealed dissociation between the subjective complaint and the test performances that showed a selective impairment in a few long‐term verbal memory tests. These patients present a characteristic clinical picture of memory disturbance as the prominent feature of partial seizures.

The Evolution of Different Types of Myoclonus During Sleep

(1) Epileptic myoclonus may persist, though decreasing, for the entire duration of sleep (Jacksonian epilepsy, epilepsia partialis continuans) or disappear in the lightest phases of sleep (degenerativ

Multiple Sclerosis with Very Late Onset: Report of Six Cases and Review of the Literature

Multiple sclerosis (MS) usually starts in young adulthood. However, the disease may appear late or very late in life. We report 6 cases with onset after the age of 59 years and review the literature. As in early onset disease, the diagnosis is mainly clinical. Laboratory findings and paraclinical evidence may support the diagnosis of clinical data are not sufficient. In elderly patients clinical history and laboratory data should be thoroughly appraised to exclude conditions more common in old age such as vascular diseases.

Classification of Partial Epilepsies According to the Symptomatology of Seizures: Practical Value and Prognostic Implications

Summary: Among 1,000 outpatient epileptics who visited the Epilepsy Center of Bologna consecutively from 1974 to 1978, 596 cases of partial epilepsy (PE) were chosen, representing 62.9% of all cases classified according to the International Classification of epilepsies. Fifty‐four of these cases (5.7% of those classifiable) that were affected by benign infantile epilepsy with rolandic spikes were not analyzed further. The remaining cases were divided up into three groups based on the symptomatology of the seizures: (1) partial elementary epilepsy (PEE), 102 cases (10.8%); (2) partial complex epilepsy (PCE), 332 cases (35%); and (3) partial secondarily generalized epilepsy (PSGE), 108 cases (11.4%). The three groups were compared according to the parameters that distinguish recognized epileptic syndromes, in order to see whether they constitute autonomous nosographic entities. Among the three groups, significant differences did not arise with regard to the incidence of single lesional etiological factors, the age of onset of the epilepsy, the neurological and psychological context, and the general features of interictal EEC PSGE instead differs significantly from the other two forms for the minor severity of the epilepsy at first examination and for its more favorable course: after at least 2 years of follow‐up under treatment, the epilepsy appeared to be controlled in 60.6% of the cases with PSGE, in 31.6% of those with PEE, and in 37.5% of those with PCE (p < 0.05). For those with PE, globally considered, only three parameters have a favorable prognostic value: the brief duration of the epilepsy at the first observation, the rarity of the seizures, and the presence of only one type of seizure.

Drop attacks: An ominous change in the evolution of partial epilepsy

We studied 16 patients with partial epilepsy and drop attacks. The drop attacks appeared 1 to 29 years after onset of epilepsy; 15 patients had these attacks weekly or daily, despite therapy. After the appearance of drop attacks, 6 patients had severe mental disorders, and social life was disrupted in 13. There was a high rate of adversive seizures, atypical absences, and diffuse spike-wave discharges in the EEG, electroclinical features that suggest a frontal origin of epilepsy. Drop attacks are ominous because they occur so frequently, resist therapy, are physically dangerous, and portend personality change.

CT scan prediction of late post-traumatic epilepsy.

Out of 233 patients admitted for head trauma during 1977-1978, 93 had a CT scan examination within the first 48 hours. Forty-nine of these had at least one clinical risk factor for post-traumatic epilepsy. Ten of this group developed post-traumatic epilepsy. In all cases early CT scan showed focal brain damage, which was related more significantly to post-traumatic epilepsy than to risk factors.

Transient topographical amnesia

Ten healthy middle aged or elderly women experienced isolated episodes of topographical amnesia without an obvious aetiology. It is likely a benign cognitive disorder, similar to transient global amnesia.

Acute upside down reversal of vision in vertebrobasilar ischaemia.

Acute upside down reversal of vision is an uncommon and little known phenomenon consisting of transient complete 180 degree inversion of the visual image. The pathogenesis and the anatomical sites of this dysfunction are unknown. Lesions involving cortical areas, mainly the parieto-occipital region, or the vestibulocerebellar system have occasionally been documented. -5 We observed two patients who experienced this bizarre visual illusion, both revealing features of vertebrobasilar

Development of Palilalia after Stereotaxic Thalamotomy in Parkinson’s Disease

A patient with Parkinson’s disease developed permanent palilalia after bilateral stereotaxic thalamotomy.